Use of System Dynamics to Investigate the Factors Affecting Patient Flow at the Karambayam Clinic

By Colleen Kinneen

“Systems thinking is a discipline for seeing wholes. It is a framework for seeing interrelationships rather than things, for seeing patterns of change rather than static snapshots. It is a set of general principles – distilled over the course of the twentieth century, spanning fields as diverse as the physical and social sciences, engineering, and management. … And systems thinking is a sensibility – for the subtle interconnectedness that gives living systems their unique character.” – Peter Senge

System dynamics is an approach used to understand, design, and manage the way complex systems change over time developed in the 1950s by Jay Forrester. While first applied to corporate and managerial problems, it has since been applied to number of social, environmental, business, engineering, and other problems. System dynamics uses a rigorous modeling method that relates system structure and behavior and identifies leverage points and potential areas of intervention within a system.

I had the wonderful privilege of interning with ICTPH and SughaVazhvu in January as a part of my concentration practicum for the Brown School of Social Work at Washington University in St. Louis, Missouri. During my time in Thanjavur, I worked with the SughaVazhvu staff to create a qualitative system dynamics model that investigated the factors influencing patient flow at the Karambayam clinic. This model found that Guides, patient satisfaction, the location of a clinic, the total cost of an outpatient visit, waiting time, and the existence of other clinics play substantial roles in influencing patient flow. The model, as well as a more in-depth description of model-based insights, can be found in the report that is attached.

Read the report here.

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